高智商成人注意缺陷多动障碍患者临床及认知功能特点分析

摘要

目的 探讨高智商成人注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)患者的临床特征及认知功能特点.方法 采用横断面研究,对符合DSM-Ⅳ诊断标准的成人高智商ADHD患者68例(高智商ADHD组)、一般智商ADHD患者42例(一般智商ADHD组)及与其年龄、智商相匹配的健康对照者(分别为高智商对照组91名和一般智商对照组51名),进行临床访谈、心理测验及执行功能问卷评定,比较各组间ADHD分型、共患病及认知功能方面的差异.结果 高智商ADHD组与一般智商ADHD组ADHD分型差异无统计学意义.高智商ADHD组共病心境障碍与焦虑障碍的比率高于一般智商ADHD组[36.8%(25/68)与19.0%(8/42),χ2=3.880,P=0.049],Barratt冲动量表中非计划得分低于一般智商ADHD组[(29.5±4.2)分与(31.4±4.3)分,t=2.102,P=0.037].高智商ADHD组与高智商对照组在智商测验中各项因子分差异均无统计学意义.一般智商ADHD组在算术(t=-2.335,P=0.020)、倒背(t=-2.021,P=0.045)及数字符号(t=-3.043,P<0.01)得分低于一般智商对照组,差异具有统计学意义.高智商ADHD组与一般智商ADHD组执行功能评定量表成人版各项得分均高于匹配智商的健康对照组(均P<0.01),高智商ADHD组的情感控制(t=-1.976,P=0.049)、工作记忆(t=-2.363,P=0.019)及行为管理指数得分(t=-2.322,P=0.021)低于一般智商ADHD组.结论 高智商ADHD患者心境障碍与焦虑障碍共患比率较高;一般智商ADHD患者注意力及工作记忆能力明显受损;ADHD患者普遍存在执行功能损害;在工作记忆、情感控制以及行为管理方面,高智商ADHD患者受损程度较轻;智商可能是ADHD患者认知功能,尤其是工作记忆能力的保护因素.%Objective To explore the clinical characters and cognitive functions in high intelligence quotient (IQ) patients with attention deficit hyperactivity disorder (ADHD) in a Chinese population sample. Methods Sixty-eight outpatients with a high IQ fulfilling the DSM-Ⅳ diagnostic criteria for ADHD,91 adults without ADHD matched by high IQ ADHD adults,42 ADHD outpatients with an average IQ and 51 normal adults with an average IQ matched were identified. All the groups were matched by age. All subjects completed the clinical interview, neuropsychological test and the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Results No significant differences in ADHD subtypes between ADHD group with high IQ and with normal IQ were found.ADHD group with high IQ had more comorbidities of mood disorder and anxiety spectrum disorders than ADHD group with normal IQ(36.8%(25/68)vs.19.0%(8/42),χ2=3.880,P=0.049).The Barratt Impulsiveness Scale-Ⅱscores of non planned were significantly lower in high IQ ADHD group than in general intelligence ADHD group(29.5± 4.2 vs. 31.4 ± 4.3,t=2.102,P=0.037). ADHD group with normal IQ performed worse than control group in test of arithmetic(t=-2.335,P=0.020), digit span(t=-2.021,P=0.045)and digit symbol(t=-3.043,P<0.01).When compared with ADHD group with normal IQ,the one with high IQ had lower scores in emotion control(t=-1.976,P=0.049),working memory(t=-2.363,P=0.019)and behavior management index(t=-2.322, P=0.021)when completing BRIEF-A questionnaire. Conclusions The ADHD group with high IQ has a higher rate of comorbidities with mood disorder and anxiety spectrum disorders.ADHD adults with normal IQ have more serious cognitive damage,especially in working memory.Both ADHD groups have executive function damages.High IQ could protect the cognitive capacity of adults with ADHD,especially in working memory aspect.